A Preliminary Trial of the Introduction of Computerised Decision Support to Assist Resuscitation of the Severely Injured in a Level 1 Trauma Centre in India

Brief name: A computerised decision support tool for trauma management The Trauma Reception and Resuscitation system, developed at The Alfred Hospital Melbourne (www.trrproject.org accessed 13 August 2017) displays patient information, captures real-time data as well as providing decision support as 'action prompts' for life saving interventions.. The system requires trained staff to input any confirmed/unconfirmed diagnoses, treatments and respond to advisory prompts to perform life saving interventions. The control group data was entered using an on-line, purpose-built tool REDCap™ secure web application (https://www.project-redcap.org/ accessed 13 August 2017). The data mirrored information being extracted by the TRR system, including date and time, anonymised patient details, vital signs, diagnoses and treatments administered. The TRR system recorded data automatically whereas, the nursing staff was required to access and record data on REDCaps at the time of event or retrospectively. TRR system trained senior nursing staff in the trauma centre provided the intervention. Senior trauma nurses will start the TRR system and administer it between 8am and 5pm when severely ill patients arrive at the Trauma Centre and are assigned into Bay 2. They will also be in charge of recording data into the online system for the control group. An overseer of the project was allocated at the site to monitor and promote adherence of the intervention during staff meetings. In brief, the TRR LCD display screen includes patient details (age, sex, allergies, weight, mechanisms of injury), vital signs, confirmed/unconfirmed diagnoses and treatments. Based on medical algorithms using vital signs and nurse inputs, it provides the trauma team with 'action prompts' or alerts to assist in decision making processes. These advisory prompts can be accepted or declined by staff, allowing clinical judgement to be made by the trauma team. It requires a dedicated trauma team member to interact with the system during resuscitation procedures. As an exception, vital signs are transferred wirelessly from a Philips MX800 monitor (Amsterdam, Netherlands). The REDCaps data include questions/short answer format, multiple choice, yes/no as well as 'other' for comments. Vital signs are to be noted by hand by looking at the Philips MX800 monitor during resuscitation. TRR system use at the Alfred Hospital resulted in improved protocol compliance and reduced errors and morbidity. Traumatic shock management errors were reduced by 26%. These results provided a rationale for implementation and system operation at the trial site.